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Schizophrenia, Catatonic Type
DSM-II For more information, see Schizophrenia * Schizophrenia, catatonic type, excited * Schizophrenia, catatonic type, withdrawn It is frequently possible and useful to distinguish two subtypes of catatonic schizophrenia. One is marked by excessive and sometimes violent motor activity and excitement and the other by generalized inhibition manifested by stupor, mutism, negativism, or waxy flexibility. In time, some cases deteriorate to a vegetative state. DSM-III For more information, see Schizophrenia The essential feature is marked psychomotor disturbance, which may involve stupor, negativism, rigidity, excitement, or posturing. Sometimes there is rapid alternation between the extremes of excitement and stupor. Associated features include stereotypies, mannerisms, and waxy flexibility. Mutism is particularly common. During catatonic stupor or excitement the individual needs careful supervision to avoid hurting self or others, and medical care may be needed because of malnutrition, exhaustion, hyperpyrexia, or self-inflicted injury. Although this type was very common several decades ago, it is now rare in Europe and North America. Diagnostic Criteria A type of Schizophrenia dominated by any of the following: # catatonic stupor (marked decrease in reactivity to environment and/or reduction of spontaneous movements and activity) or mutism # catatonic negativism (an apparently motiveless resistance to all instructions or attempts to be moved) # catatonic rigidity (maintenance of a rigid posture against efforts to be moved) # catatonic excitement (excited motor activity, apparently purposeless and not influenced by external stimuli) # catatonic posturing (voluntary assumption of inappropriate or bizarre posture) DSM-IV For more information, see Schizophrenia The essential feature of the Catatonic Type of Schizophrenia is a marked psychomotor disturbance that may involve motoric immobility, excessive motor activity, extreme negativism, mutism, peculiarities of voluntary movement, echolalia, or echopraxia. Motoric immobility may be manifested by catalapsy (waxy flexibility) or stupor. The excessive motor activity is apparently purposeless and is not influenced by external stimuli. There may be extreme negativism that is manifested by the maintenance of a rigid posture against attempts to be moved or resistance to all instructions. Peculiarities of voluntary movement are manifested by the voluntary assumption of inappropriate or bizarre postures or by predominant grimacing. Echolalia is the pathological, parrotlike, and apparently senseless repetition of a word or phrase just spoken by another person. Echopraxia is the repetitive imitation of the movements of another person. Additional features include stereotypies, mannerisms, and automatic obedience or mimicry. During severe catatonic stupor or excitement, the person may need careful supervision to avoid self-harm or harming others. There are potential risks from malnutrition, exhaustion, hyperpyrexia, or self-inflicted injury. To diagnose this subtype, the individual's presentation must first meet the full criteria for Schizophrenia and not be better accounted for by another etiology: substance induced (e.g., Neuroleptic-Induced Parkinsonism) a general medical condition, or a Manic or Major Depressive Episode. Diagnostic Criteria A type of Schizophrenia in which the clinical picture is dominated by at least two of the following: # motoric immobility as evidenced by catalepsy (inlcuding waxy flexibility) or stupor # excessive motor activity (that is apparently purposeless and not influenced by external stimuli) # extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism # peculiarities of voluntary movement as evidence by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing # echolalia or echopraxia DSM-5 See Schizophrenia